Are screens the enemy? A battle over what's best for teens

A new study has found links between screen time and depressive symptoms and thoughts of suicide in adolescents — but it's not time to throw the smartphone out the window just yet, experts say.

The study, published earlier this month in Clinical Psychological Science, found that 48 percent of teens who spent five or more hours online each day had one suicide risk factor — such as depression, thinking about, making a plan or attempting suicide. That was 66 percent higher than the teens who only spent one hour a day on phones.

"Something is going on (with teens)," study author Jean Twenge, a professor of psychology at San Diego State University and generations researcher, told the Deseret News, "and we need to figure out what it is so we can help them."

Another finding showed that young women, in particular, are struggling. From 2010 to 2015, the rate of female teens scoring high in depressive symptoms jumped almost 58 percent, compared to a nearly 9 percent increase for males. In fact, college mental health counselors have seen a 30 percent caseload increase from 2009-2010 to 2014-2015.

While there's no truly conclusive data yet, Twenge believes the increasing struggles among adolescents are linked to a rise in smartphone ownership, which according to the Pew Research Center data, crossed the 50 percent mark for adults in late 2012 or early 2013.

And Twenge isn't shy about sharing these ideas, both through her book, "iGen: Why Today's Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy — and Completely Unprepared for Adulthood — and What That Means for the Rest of Us," and recent articles for The Atlantic ("Have Smartphones Destroyed a Generation?"), the Washington Post and The Conversation.

Yet some experts are pushing back, arguing that if parents, lawmakers or advocates jump to conclusions and single out smartphones as the primary source of teens' troubles, it might stifle a healthy debate about a variety of factors, including economic pressures, family instability, lack of exercise and sleep, poor diet, socioeconomic status and even homework.

"We'd want to remember that there are bound to be a lot of factors at play," says Bruce C. Poulsen, chief psychologist at Primary Children's Hospital, who is urging discussion, not hand-wringing.

He too worries about the health of teens, and while the study brings up interesting questions and the large data set makes it hard to dismiss, he's not ready to label "digital culture" as entirely bad because of the many significant upsides to new technology.

"The problem, as we have come to understand through our research, is there are few simple answers — and certainly no single answer that can be applied to explain the mental health and well-being of an entire generation," wrote Katie Davis, assistant professor at the University of Washington Information School and founding member of the UW Digital Youth Lab.

"Though perhaps inconvenient," Davis continued in her critique of Twenge's study, "it's essential to acknowledge and grapple with the complexity of young people's digital media use."

Causation versus correlation

Twenge doesn't believe she's oversimplifying things in her research, as this study relied on answers from more than 500,000 youths in two nationally representative surveys: "Monitoring the Future," which interviews eighth-, 10th- and 12th-graders, and "The Youth Risk Behavior Surveillance System," which includes 9th through 12th graders.

To gauge depression, students agreed or disagreed on a five-point scale with statements like, "Life often seems meaningless," "I feel that I can't do anything right," and "It feels good to be alive."

For suicide ideation/behaviors, students were asked to think about the past 12 months and answer yes or no to four questions: "Did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?" "Did you ever seriously consider attempting suicide?" "Did you make a plan about how you would attempt suicide?" and "Did you actually attempt suicide?"

Students were also asked about their electronic device use, social media use, use of internet news and print media, sports or exercise, in-personal social interaction, homework, TV watching, religious experience and whether they had a paying job.

And Twenge found some interesting connections.

Teens who spent more time with screens were significantly more likely to have "high depressive symptoms or at least one suicide-related outcome," while those who spent time exercising, interacting with friends in-person, doing homework, working at a job or even going to church were less likely to have depressive symptoms or suicidal thoughts.

On first glance, it may seem as if the data are saying that screen time causes depression, or that being a heavy social media user will make someone suicidal, yet Twenge and all the experts the Deseret News spoke with said that despite the interesting linkages between data, the connections cannot prove that one caused the other.

"That's the chicken and the egg question," said James Ott, a licensed clinical social worker at Red Willow Counseling in Salt Lake City. "Do relationships cause instability or is it instability that finds bad relationships? Are you dysfunctional because of alcohol or does alcohol (use come from) the dysfunction? That's the million-dollar question."

But it's not just one study that points out links between increasing screen time and negative health outcomes.

Twenge cites three other studies of adults that offer more evidence that using social media causes depression, rather than the other way around.

The first study found that the more frequently adults used Facebook, the more negative their mood was when asked about it by researchers in daily text messages.

A second experimental study in Denmark randomly assigned adults to either continue Facebook use or give it up for a week. Those who abstained from Facebook reported fewer depressive symptoms at the end of a week than their regular using peers.

The third study used longitudinal assessments a year apart to evaluate psychological well-being, finding that Facebook use lowered it, but in-person socializing increased it.

However, in contrast, another study found that impacts on teens' mental health depended on when the media was used (weekday or weekend) and that when used in moderation, social media may actually be "advantageous in a connected world."

"Yes, we need more experiments," Twenge told the Deseret News. "It's difficult to tell if screen time is causing depression or depression is causing screen time. However, given the data we have at the moment … the outcome by my reading is to recommend that screen time be two hours a day or less."

A better conversation

In his 20 years of working with teens, Poulsen at Primary Children's Hospital has definitely seen an increase in the rates of depression and suicidal behavior, but he also knows that today's teens are more likely to report how they're feeling, both because the stigma is lessening and because teens are often more open in general.

As to why teenage girls may be feeling more depressed than young men — and have a suicide rate that has risen 65 percent between 2010 and 2015 — experts muse that perhaps the visual emphasis of social media impacts girls differently than boys.

Social networking creates "super peer groups" that can "astronomically" magnify the normal challenges a teenage girl might face, said Victor Strasburger, a distinguished professor of pediatrics emeritus at the University of New Mexico School of Medicine.

"The degree of difficulty has risen dramatically," Strasburger said. "If comic books were a zero, and TV and movies are a 5, we're now looking at an 8 or 9 on a scale of 10."

Which means it's time for some lessons in media literacy for the whole family, says Strasburger, as well as rules to keep media use at healthy levels.

When Poulsen works with families and teens, he approaches it from the angle of "adding to their menu of things that they can do, and ways that they can interact with people, rather than just taking things away," he says.

Many GenX parents (those born in the early to mid-1960s to the early 1980s) tend to see digital devices as an incredible luxury, while their kids see them as something akin to public utilities, like running water, says Poulsen.

So, rather than simply taking phones away, parents can embrace opportunities to talk to their kids about their media use and their mental health.

"We should use (this study) as a springboard for more discussion and more attention to how we manage new media," Poulsen says. "We shouldn't look at this as, OK, the jury is in, all this stuff is bad and causing depression — it's just too complicated."

Depression is a bio-psycho-social disorder, he says, and if teens are using technology to strengthen their social relationships, that's a good thing. However, less obvious impacts of "digital culture" may also influence depression, like phone use cutting into exercise time or sleep time, a known protector against depression.

Rather than focus on the sheer time spent on a phone, researchers at the Media Policy Project, London School of Economics and Political Science, have proposed considering instead the three C's of media use.

They recommend parents evaluate context ("Where are kids getting their media?"), content ("What are they watching?") and connections ("Is this helping or harming their relationships?"), according to a 2016 policy brief.

Those questions recognize that "screen time" is not one big thing, but comes in a variety of "shapes, forms and sizes," says Amy Orben, college lecturer at the Queens College, University of Oxford, and another critic of Twenge's recent study.

Orben would like to see future studies ask more nuanced questions about screen time and social media use. For example, the current YRBSS questions ask if kids use social media "a few times a year, once or twice a month, at least once a week and almost every day," which she says doesn't accurately reflect today's teens' media habits.

What Orben doesn't want to see is research that scares parents who respond by clamping down on tech use, further disconnecting them from their kids.

Yes, scientific research is slow, Orben says, but "the better way forward is when there's still a scientific debate. What we're trying to say is we don't know yet, and we need to really communicate the uncertainty."

Twenge is ready for an ongoing debate, though she'd like to change the status quo to stop "thinking of smartphones as harmless."

She doesn't advocate ripping phones out of the hands of high schoolers, but she does want to see more parent/child conversations about media use and discussion of the factors that seem to insulate kids from depression and suicide, such as exercise, sports, in-person interaction and good sleep.

"What's the risk of doing nothing?" Twenge says, "If there's even a chance that high levels of screen time have something to do with the rising teen suicide and depression rate, that's a big risk."